Worldwide, cancer is a leading cause of death and the most common killer of adult Americans. For the individual, the diagnosis is accompanied by extreme stress. Multiple randomized clinical trials (RCTs) of psychological interventions have shown efficacy in reducing stress for the "typical" patient-newly diagnosed with local or regional disease. Unfortunately, only two (N=2) RCTs have focused upon the patient with recurrent disease, leaving this patient group adrift in the sea of previous and present day cancer control research. The proposed project is designed to address this important need, by refining and pilot testing a promising intervention. A two-phase project, accruing patients newly diagnosed cancer recurrence (N=96) is proposed. Breast or gynecologic patients will be accrued, as these are the 1st and 3rd most prevalent sites among women and together account for 40% of annual diagnoses. Phase I will employ a focus group methodology for three aims: 1) provide clinical detail on the unique needs of patients facing recurrence;2) understand the frequency and perceived effectiveness of patients'own coping strategies;and, 3) solicit patient perceptions of intervention strategies shown to be effective with other cancer populations. Using these data, we will modify a previously tested psychological treatment-the Biobehavioral Intervention (BBI;Andersen et al., 2004;2007;in press)- found to be effective for reducing Stage II/III breast cancer patients'stress, improving health behaviors and treatment adherence, enhancing immunity, and reducing the risk of recurrence and death. In Phase II the revised intervention will be pilot tested to achieve three aims: 1) test the acceptability and feasibility of the intervention;2) test of the efficacy of the intervention to affect biobehavioral outcomes;and 3) assemble clinical detail, estimate effect sizes, and discover factors producing variability in patient outcomes, if any. The intervention will be tested in both individual and group formats with the latter including both homogeneous and heterogeneous disease site patient participants. Completion of both phases leads an experienced investigator group to their over arching aim: Conduct of a randomized clinical trial testing the efficacy of a psychological intervention tailored to the needs of this important, but underserved, cancer patient group. PUBLIC HEALTH RELEVANCE: With over 1.3 million new cancer diagnoses per year, more than half a million individuals will face recurrence and succumb to their disease. Despite the numbers, little psychosocial research has focused on the plight of those with recurrence. This research advances public mental health by providing an important first step in developing and testing a psychological intervention to decrease psychological symptoms and improve health, thereby reducing burden to cancer patients, their families, and the health care system.